By Harriet Hall, MDQuestion: Why on earth do they give Hepatitis B shots to newborn infants? It’s a sexually transmitted disease, and infants don’t have sex.

Answer: Vaccine recommendations weren’t just made up out of thin air. There are very good reasons to give Hep B at birth.

It isn’t just sexually transmitted; it’s also transmitted from mother to infant and from child to child, through contact with blood or other body fluids. A child might catch it from using another child’s toothbrush or from contact with another child’s cuts or scrapes. The disease can be asymptomatic, especially in children; so someone could be infected and infectious to others and not know it. Hepatitis B can result in chronic infection, cirrhosis, and liver cancer; hepatitis B infections cause 60% of all liver cancer, 316,000 cases a year worldwide. Children are more likely than adults to develop chronic disease if infected, so it makes sense to start the series of Hep B shots as early as possible. Mothers can be tested for Hep B infection, and if the mother is known to be infected, the baby gets a shot of hepatitis B immune globulin (HBIG) along with the vaccine. But the test is not perfect, and the mother might have a false negative test, or she might contract the infection after the test is done.Since 1982, when the hepatitis B vaccine became available in the U.S., more than 100 million people have been vaccinated with no reports of serious side effects. Since 1982, the incidence of acute hepatitis B has declined by about 82%.A landmark study in 1997 showed that a 12-year nationwide vaccination program against hepatitis B virus in Taiwan resulted in a significant reduction in the number of cases of childhood liver cancer. It works. We have a vaccine that can prevent cancer; it would be foolish not to use it.In summary, hepatitis B vaccine is safe, effective, reduces the incidence of liver cancer, and provides the best protection for children when it is given at birth.

Question: I recently stumbled onto some information about an Indian supplement called Bacopa monnieri. Just out of curiosity I searched Medscape and was surprised to find a meta-analysis that seems to support the claims. The prospect of improved memory and less anxiety is an enticing one. What do you think?

“This meta-analysis suggests that Bacopa monnieri has the potential to improve cognition, particularly speed of attention but only a large well designed 'head-to-head' trial against an existing medication will provide definitive data on its efficacy on healthy or dementia patients using a standardized preparation.”

There is some evidence to suggest that Bacopa improves memory free recall with evidence for enhancement in other cognitive abilities currently lacking [emphasis added] perhaps due to inconsistent measures employed by studies across these cognitive domains. Research…is in its infancy, with research still yet to investigate the effects of Bacopa across all human cognitive abilities. Similarly, future research should examine... varied dosages and across different extracts.”

Both of these said the evidence only “suggests,” and they said better research was needed; they were far from definitive. And something doesn’t add up: the two reviews found different effects (speed of attention vs. memory free recall).Meta-analyses are better than single studies, but they are only as good as the studies they review. A single large well-designed study can trump the results of a meta-analysis, and the results of meta-analyses do not predict future scientific conclusions.I checked the Natural Medicine Comprehensive Database, which I consider the most reliable source. They rate Bacopa as “possibly effective” - below their ratings of “likely effective” and “effective.” They reviewed all the published studies and here’s what they said:

“POSSIBLY EFFECTIVE for cognitive function. Some clinical research shows that taking a specific Bacopa extract (KeenMind, Flordis), 300-450 mg daily for 12 weeks, seems to improve some measures of verbal learning, memory, and information processing in healthy men and women. Another clinical trial shows that taking a different Bacopa extract (BacoMind, Natural Remedies) 300 mg daily for 12 weeks also significantly improves measures of verbal learning, memory, and retention in healthy adults over 55 years of age. In children aged 6-8 years, taking one teaspoon of Bacopa extract three times daily for 3 months seems to improve visual motor function and immediate memory compared to pretreatment.”

They rate it as only “possibly safe” and point out that long-term safety studies have not been done; clinical trials have lasted only up to 12 weeks.The appropriate dosage or best preparation has not been established.They report adverse reactions of increased stool frequency in 30% of patients, nausea in 18%, and abdominal cramps in 16% of patients in clinical trials, with other less common side effects of dry mouth, fatigue, flatulence, bloating, decreased appetite, headache, insomnia, and vivid dreams. They also report interactions with various types of drugs and various diseases and conditions. Their information is up to date as of 12/23/2014.My approach to this kind of thing is to withhold judgment pending better studies and more complete information. I’ll stay tuned, with interest. That is, if my aging brain can remember to stay tuned without the help of Bacopa. :-)

Question: My son has autism. I am told that 750 mg to 1 G of EPA and DHA per day may enable better behaviors after about 12 weeks. Do you think it would be effective?

This website has a good summary of evidence-based interventions for autism It doesn’t even mention omega-3’s.

I am not optimistic about the potential benefit of omega-3’s. On the other hand, a short therapeutic trial probably wouldn’t cause any harm.

Questions for Ask the Skepdoc can be sent to editor@randi.org

Harriet A. Hall is a retired family physician, former U.S. Air Force flight surgeon, and health advocate who writes about alternative medicine and quackery for Skeptic magazine, Skeptical Inquirer and Science-based Medicine.

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